Changing pattern of acute intestinal obstruction in a tropical African population

A study of one hundred and forty-two patients with acute intestinal obstruction over a period of ten years (January 1985-December 1994) at Wesley Guild Hospital was undertaken to determine the pattern and outcome of this problem in a tropical African population. There was a preponderance of males over females; ratio 1.7:1. Mean age was 33 years and over half of the patients were aged between two and 30 years. There was a second peak age incidence among elderly patients between 50-80 years. Abdominal pain, vomiting and constipation were common symptoms, while abdominal distension and tenderness were common clinical findings. Intraperitoneal adhesions were responsible in 41.5%; there was associated intestinal volvulus in 25.4% of the cases of intraperitoneal adhesions. In 16.9%, strangulated external hernia was responsible for acute intestinal obstruction. Small intestinal volvulus was encountered in 20 cases (14.1%) and associated with adhesion in 75% of the cases. Intussusception occurred in 14.1% of cases of which 70% of the patients were below the age of 15 years. In 15 (10.6%) patients, there were volvulus of the sigmoid colon, with 80% (12 patients) having gangrenous bowel segments. Ascaris were responsible in 3.5% of the patients and large bowel tumour in 2.8%. Other rare causes were internal hernia and ileal pseudo obstruction. Adhesiolysis and intestinal resection were the commonest operative procedures. Common complications were wound infection in 16.2%, postoperative fever in 10.6% and chest infection in 9.1%. A mortality rate of 8.4% was recorded.